BLOOD, Transfusion of. - The first hint of a transfusion of blood, carried out however by taking blood by mouth, can already be glimpsed in the works of Pliny, in the anatomical treatise of Herophilus, in the eighth book of Ovid's Metamorphoses, and also in ancient Hebrew texts.
In the chronicle of Rome written by Stefano Infessura, it is said that in 1492 a Jewish physician attempted to transfuse into the veins of the ailing Innocent VIII, for the purpose of curing him, the blood of three ten-year-old children; the episode, however, cannot be historically proven and in particular is denied by Pastor in his History of the Popes.
The first certain report of transfusion dates only from 1667, the year in which a certain Denys, professor of mathematics and philosophy in Paris, is said to have made the first attempt to introduce the blood of a lamb into a demented boy for therapeutic purposes. The experiment, carried out by directly connecting the two vessels by means of a silver cannula, succeeded happily, but this practice, though finding numerous supporters throughout the world, was often opposed both by physicians and by civil and religious authorities, partly because of the frequent cases of failure, partly because of prejudices of a moral and legal nature. In 1669, indeed, both the supreme Court and the French Parliament, as well as the Holy See, prohibited the practice of transfusion, considering it an immoral act.
After varying fortunes, it may be said that transfusion began to establish itself only in the second half of the 19th century through the work of scientists throughout the world: Prevost, Dumas, Karst, Bischoff, Carrel, Gille, Sabbatani, and especially Landsteiner, the discoverer of blood groups. At present transfusion has entered medical practice, not only for the purpose of replacing a possible serious loss of blood, but also for therapeutic purposes in various morbid conditions. It appears, in fact, by now established that transfusion, besides replacing the lost blood, possesses an action that mobilizes the blood reserves, is tonic on the peripheral circulation, hematopoietic, antihemolytic, hemostatic, antitoxic, and anti-infective, as well as organotherapeutic.
Normally transfusion can be carried out with homologous blood (drawn from individuals of the same species), with blood derivatives (plasma, serum, concentrated red cells or white cells...), with heterologous blood and plasma (drawn from beings of a different species), with artificial solutions used as blood substitutes. Now transfusions are practiced almost exclusively with human blood or with its derivatives, animal-blood transfusions having been abandoned.
Among the methods in use, one must consider: a direct transfusion (the blood passes directly from the donor to the recipient, by means of special instruments); an indirect transfusion, used today more frequently after the discovery of the anticoagulant properties of sodium citrate made by Sabbatani in 1902 (the blood is first collected in suitable containers or flasks containing the anticoagulant substances, where it can be preserved even for three, four, five days). Besides these two methods, mention should be made of the transfusion of preserved blood drawn from cadavers; such blood has the advantage of no longer having the capacity to coagulate and of being able to be preserved for 3-4 weeks. The method was introduced by Yudin in 1930 in Moscow. In the United States studies are under way to achieve long preservation of blood, without alteration of its components, by means of coagulation.
Although it has entered daily medical practice, transfusion still has the character of an intervention of some importance, such as to engage the physician's responsibility with regard both to its indications and contraindications, and to the preservation and choice of the blood, and to its technical execution.
The main problem at the present time is that of the choice of blood; this is governed by the rule that: "the blood of the recipient must not contain antibodies that act on the red cells of the donor."
Landsteiner in fact in 1900 and a few years later Jansky and Moss discovered the well-known "blood groups," classifying all men into the groups: A, B, AB, O (zero) according to the presence or absence of certain "antigens" (agglutinogens) contained in their red cells and of certain "antibodies" (agglutinins) present in their plasma. If the choice of the donor is not made appropriately, there may be brought about in the recipient's blood a possible encounter between an agglutinogen and an agglutinin of the same name (for example: red cells of the donor with agglutinogen A and plasma of the recipient with anti-A agglutinin), whence serious reactions and even danger to the patient's life. Hence the absolute necessity of determining with every care the belonging of the donor and the recipient to the different groups and of taking into account their respective tolerances before practicing a transfusion. At present the blood groups have notably increased in number, both through the discovery of new systems (MNS, P, Kell-Cellano, Rh, Lutheran, Lewis, Jobbins, etc.), and through the identification of numerous subgroups. In practice, however, from the transfusion standpoint only the ABO system and the Rh system discovered by Landsteiner-Wiener in 1940 are important. The importance of this Rh factor has today become so great that from the legal standpoint it is held to be a duty for a physician to transfuse Rh-negative blood in many cases and especially in young women, since a possible transfusion with Rh-positive blood could determine serious alterations in the event of a pregnancy involving the fetus, if the latter presents in its blood the characteristics of an Rh positive of paternal origin. In some of these cases, if the fetus comes to term, the newborn presents the characteristics of a particular disease: "fetal erythroblastosis," which is in fact treated solely with the so-called "exchange transfusion" or total replacement of the blood (v. PATERNITY, investigation of).
In the choice of the donor, besides group incompatibility, one must bear in mind the danger of transmitting certain diseases through transfusion: such as malaria, syphilis, and especially epidemic hepatitis (unfortunately often unavoidable, unless one uses blood sterilized with radium or strongly ionizing rays).
As regards the dangers of transfusion, one must always bear in mind the possibility of the onset of local and general reactions even after the choice of the appropriate group. The mortality rate varies notably according to the authors: Tzanck gives a rate of 1/300, Bazzocchi and Bendandi 1/2500; Domenici has had no case of death out of 10,500 cases.
By most jurists transfusion is today considered a lawful act, even without the donor's consent, provided that in this way a person must be saved from an "actual danger of grave harm, not otherwise avoidable." However the law, for example in Italy, provides that the physician's responsibility must be engaged in the case of: performance with contraindications (grave cardiac, renal, hepatic lesions...), failure to perform in the course of absolute indications (intense hemorrhage), erroneous choice of blood, errors of technique (D. M. 20300/2 of 3 June 1935 and of 13 Dec. 1937).
From the moral standpoint the donation of a portion of one's own blood must be considered lawful provided that the extent of the withdrawal is not such as to endanger life or to cause grave harm to the donor's health (v. MUTILATION). In determined circumstances, representing the only possibility of saving an individual from death, refusing, without the motive of grave harm to oneself, the donation of a fair portion of one's own blood represents a grave fault against charity. On the other hand the physician cannot withdraw blood from an individual, or in a greater quantity than he is aware of, to use it for the purpose of transfusion, without that person's consent.